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<< Noninvasive Airway Management Techniques: How And When To Use Them


Evidence-based medicine requires a critical appraisal of the literature based upon study methodology and number of subjects. Not all references are equally robust. The findings of a large, prospective, randomized, and blinded trial should carry more weight than a case report. To help the reader judge the strength of each reference, pertinent information about the study, such as the type of study and the number of patients in the study, will be included in bold type following the reference, where available. In addition, the most informative references cited in the paper, as determined by the authors, will be noted by an asterisk (*) next to the number of the reference.

  1. * Hotchkiss JR, Marini JJ. Noninvasive ventilation: An emerging supportive technique for the emergency department Ann Emerg Med 1998;32:470-479. (Review; 53 references)
  2. Poulton EP, Oxon DM. Left-sided heart failure with pulmonary oedema: Its treatment with the "pulmonary plus pressure machine." Lancet 1936;231:981-983. (Anecdotal report; included for historical interest only)
  3. Lim CM. Renaming BiPAP. Crit Care Med 2000;28:2180. (Letter to the editor)
  4. Corrado A, Bruscoli G, Messori A, et al. Iron lung treatment of subjects with COPD in acute respiratory failure: evaluation of short- and long-term prognosis. Chest 1992;101:692-696. (Retrospective; 105 adult patients)
  5. * Martin TJ, Hovis JD, Costantino JP, et al. A randomized, prospective evaluation of noninvasive ventilation for acute respiratory failure. Am J Respir Crit Care Med 2000;161(3 Pt 1):807-813. (Prospective, comparative, randomized, controlled; 61 patients)
  6. Pollack C Jr, Torres MT, Alexander L. Feasibility study of the use of bilevel airway pressure for respiratory support in the emergency department. Ann Emerg Med 1996;27:189- 192. (Convenience sample; 50 adult patients)
  7. Celikel T, Sungur M, Ceyhan B, et al. Comparison of noninvasive positive pressure ventilation with standard medical therapy in hypercapnic acute respiratory failure. Chest1998;114:1636-1642. (Randomized, prospective; 30 adult patients)
  8. * Antonelli M, Conti G, Rocco M, et al. A comparison of noninvasive positive-pressure ventilation and conventional mechanical ventilation in patients with acute respiratory failure. N Engl J Med1998;339:429-435. (Randomized; 64 adult patients)
  9. Vitacca M, Clini E, Pagani M, et al. Physiologic effects of early administered mask proportional assist ventilation in patients with chronic obstructive pulmonary disease and acute respiratory failure. Crit Care Med 2000;28:1791-1797. (Prospective physiologic trial; 7 adult patients)
  10. Poponick JM, Renston JP, Bennett RP, et al. Use of a ventilatory support system BiPAP for acute respiratory failure in the emergency department. Chest 1999;116:166-171. (Case series; 58 adult patients)
  11. * Wysocki M, Tric L, Wolff MA, et al. Noninvasive pressure support ventilation in patients with acute respiratory failure. A randomized comparison with conventional therapy. Chest 1995;107:761-768. (Randomized; 41 adult patients
  12. * Kramer N, Meyer TJ, Meharg J, et al. Randomized, prospective trial of noninvasive positive pressure ventilation in acute respiratory failure.Am J Resp Crit Care Med 1995;151:1799-1806. (Randomized; 31 adult patients)
  13. Wood KA, Lewis L, Von Harz B, et al. The use of noninvasive positive pressure ventilation in the emergency department. Results of a randomized clinical trial. Chest 1998;113:1339-1346. (Randomized; 27 adult patients)
  14. * Bach PB, Brown C, Gelfand SE, et al. American College of Physicians—American Society of Internal Medicine. American College of Chest Physicians. Management of acute exacerbations of chronic obstructive pulmonary disease: a summary and appraisal of published evidence. Ann Intern Med 2001;134(7):600-620. (Meta-analysis, guideline
  15. * Bersten AD, Holt AW, Vedig AE, et al. Treatment of severe cardiogenic pulmonary edema with continuous positive airway pressure delivered by face mask. N Engl J Med 1991;325:1825-1830. (Randomized; 39 adult patients)
  16. Confalonieri M, Gazzaniga P, Gandola L, et al. Haemodynamic response during initiation of non-invasive positive pressure ventilation in COPD patients with acute ventilatory failure.Respir Med 1998;92(2):331-337. (Regression analysis; 18 patients)
  17. Fellahi JL, Valteir B, Beauchet A, et al. Does positive end-expiratory pressure ventilation improve left ventricular function? A comparative study by transesophageal echocardiography in cardiac and noncardiac patients. Chest 1998;114:556-562. (Prospective, comparative; 12 patients)
  18. Vieira SR, Puybasset L, Lu Q, et al. A scanographic assessment of pulmonary morphology in acute lung injury. Significance of the lower inflection point detected on the lung pressure-volume curve. Am J Resp Crit Care Med 1999;159:1612-1623. (14 patients)
  19. Schwartz DE, Matthay MA, Cohen NH. Death and other complications of emergency airway management in critically ill adults.Anesthesiology 1996;82:367-376. (Prospective; 238 adult patients)
  20. Bauer TT, Ferrer R, Angrill J, et al. Ventilator-associated pneumonia: incidence, risk factors, and microbiology. Semin Respir Infect2000;15(4):272-279. (Review; 47 references)
  21. Stauffer JL, Olson DE, Petty TL. Complications and consequences of endotracheal intubation and tracheotomy: A prospective study of 150 critically ill adult patients. Am J Med 1981;70:65-76. (Prospective; 150 adult patients)
  22. Deutschman CS, Wilton P, Sinow J, et al. Paranasal sinusitis associated with nasotracheal intubation: a frequently unrecognized and treatable source of sepsis. Crit Care Med 1986;14(2):111-114. (Comparative; 27 patients)
  23. * Orebaugh SL. Initiation of mechanical ventilation in the emergency department. Am J Emerg Med 1996;14:59-69. (Very useful review of principles of mechanical ventilation)
  24. * Girault C, Richard JC, Chevron V, et al. Comparative physiologic effects of noninvasive assist: control and pressure support ventilation in acute hypercapnic respiratory failure. Chest 1997;111:1639-1648. (Randomized, controlled; 15 patients)
  25. Kosowsky JM, Storrow AB, Carleton SC. Continuous and bilevel positive airway pressure in the treatment of acute cardiogenic pulmonary edema. Am J Emerg Med2000;18:91. (Review)
  26. Brochard L, Mancebo J, Wysocki M, et al. Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease. N Engl J Med 1995;333:817-822. (Prospective, randomized; 85 patients)
  27. Patrick W, Webster K, Ludwig L, et al. Noninvasive positive-pressure ventilation in acute respiratory distress  without prior chronic respiratory failure. Am J Respir Crit Care Med 1996;153(3):1005-1011. (11 patients
  28. * Meduri GU, Turner RF, Abou-Shala N, et al. Noninvasive positive pressure ventilation via facemask—First-line intervention in patients with acute hypercapnic and hypoxemic respiratory failure. Chest 1996;109:179-193. (Prospective, uncontrolled; 158 adult patients
  29. Craven RA, Singletary N, Bosken L, et al. Use of bilevel positive airway pressure in out-of-hospital patients. Acad Emerg Med 2000;7(9):1065-1068. (Prospective; 71 patients)
  30. Gardtman M, Waagstein L, Karlsson T, et al. Has an intensified treatment in the ambulance of patients with acute severe left heart failure improved the outcome? Eur J Emerg Med2000;7(1):15-24. (158 patients)
  31. Lien TC, Wang JA, Wu TC. Short term effects of nasal pressure support ventilation in acute exacerbation of hypercapnic COPD. Chin Med J 1996;57:335-342. (Prospective series; 10 adult patients)
  32. * Sherk PA, Grossman RF. The chronic obstructive pulmonary disease exacerbation. Clin Chest Med2000;21:705-721. (Very good review of pathophysiology and treatment of COPD exacerbations)
  33. * Ferguson GT. Recommendations for the management of COPD. Chest 2000;117:23-28. (Review)
  34. * Hoo GWS, Hakimian N, Santiago SM. Hypercapnic respiratory failure in COPD patients, response to therapy. Chest 2000;117:169-177. (Retrospective review; 138 adult patients)
  35. * Bott J, Carroll MP, Conway JH, et al. Randomised controlled trial of nasal ventilation in acute ventilatory failure due to chronic obstructive airways disease.Lancet 1993;341:1555-1557. (Prospective, randomized, controlled; 60 patients)
  36. Barbe F, Togores B, Rubi M, et al. Noninvasive ventilatory support does not facilitate recovery from acute respiratory failure in chronic obstructive pulmonary disease. Eur Respir J1996;9:1240-1245. (Randomized, non-acute study; 24 patients)
  37. Ahmed AH, Fenwick L, Angus RM, et al. Nasal ventilation versus Doxapram in the treatment of type II respiratory failure complicating chronic outflow obstruction. Thorax 1992;47:A858. (Randomized)
  38. Keenan SP, Brake D. An evidence-based approach to noninvasive ventilation in acute respiratory failure. Crit Care Clin 1998;14:359-372. (Review, meta-analysis)
  39. Keenan SP, Kernerman PD, Cook DJ, et al. The effect of noninvasive positive pressure ventilation on mortality in patients admitted with acute respiratory failure. A meta-analysis. Crit Care Med 1997;25:1685-1692. (Review, meta-analysis)
  40. * Keenan SP, Gregor J, Sibbald WJ, et al. Noninvasive positive pressure ventilation in the setting of severe, acute exacerbations of chronic obstructive pulmonary disease: More effective and less expensive. Crit Care Med2000;28:2094-2102.(Meta-analysis and economic evaluation of treatment)
  41. Confalonieri M, Parigi P, Sartabellati A, et al. Noninvasive mechanical ventilation improves the immediate and long-term outcome of COPD patients with acute respiratory failure. Eur Resp J 1996;9:422-430. (Case control; 48 adult patients)
  42. Mehta S, Jay GD, Woolard RH, et al. Randomized, prospective trial of bilevel vs continuous positive airway pressure in acute pulmonary edema. Crit Care Med1997;25:620-628. (Randomized; 30 patients)
  43. Perel A, Williamson DC, Modell JH. Effectiveness of CPAP by mask for pulmonary edema associated with hypercarbia. Intensive Care Med 1982;9:17-19. (Case series report)
  44. Vaisanen IT, Rasanen J. Continuous positive airway pressure and supplemental oxygen in the treatment of cardiogenic pulmonary edema. Chest 1987;92:481-485. (Case series report)
  45. Lin M, Chiang HT. The efficacy of early continuous positive airway pressure therapy in patients with acute cardiogenic pulmonary edema. J Formosan Med Assoc 1991;90:736-743. (Case series report)
  46. Kelly AM, Georgakas C, Bau S, et al. Experience with the use of continuous positive airway pressure (CPAP) therapy in the emergency management of acute cardiogenic pulmonary oedema. Aust N Z J Med 1997;27:319-322. (Retrospective chart review; 75 patients)
  47. Sacchetti AD, Harris RH, Paston C, et al. Bi-level positive airway pressure support system use in acute congestive heart failure: Preliminary case series. Acad Emerg Med 1995;2:714. (Retrospective case series; 22 adult patients)
  48. Rasanen J, Heikkila J, Downs J, et al. Continuous positive airway pressure by face mask in acute cardiogenic pulmonary edema. Am J Cardiol 1985;55:296-300. (Randomized; 40 adult patients)
  49. * Lin M, Yang YF, Chiang HT, et al. Reappraisal of continuous positive airway pressure therapy in acute cardiogenic pulmonary edema. Short-term results and long-term follow up. Chest 1995;107:1379-1386. (Randomized; 100 adult patients)
  50. Masip J, Betbese AJ, Paez J, et al. Non-invasive pressure support ventilation versus conventional oxygen therapy in acute cardiogenic pulmonary oedema: a randomised trial. Lancet 2000;356(9248):2126-2132. (Randomized, controlled; 40 patients)
  51. Pang D, Keenan SP, Cook DJ, et al. The effect of positive pressure airway support on mortality and the need for intubation in acute cardiogenic pulmonary edema. Chest 1998;114:1185-1192. (Meta-analysis)
  52. Takeda S, Nejima J, Takano T, et al. Effect of nasal continuous positive airway pressure on pulmonary edema complicating acute myocardial infarction. Jpn Circ J 1998;62(8):553-558. (Randomized, controlled; 29 patients)
  53. * Sharon A, Shpirer I, Kaluski E, et al. High-dose intravenous isosorbide-dinitrate is safer and better than Bi-PAP ventilation combined with conventional treatment for severe pulmonary edema. J Am Coll Cardiol 2000;36(3):832- 837. (Randomized, controlled; 40 patients)
  54. Ntoumenopoulos G. Limitations to study on noninvasive ventilation. Chest 1999;115:303. (Letter to the editor
  55. Centers for Disease Control and Prevention. Forecasted state-specific estimates of self-reported asthma prevalence— United States, 1998. MMWR Morb Mortal Wkly Rep 1998;47:1022-1025. (Retrospective)
  56. Mannino DM, Homa DM, Pertowski CA, et al. Surveillance for asthma—United States, 1960-1995. MMWR Morb Mortal Wkly Rep 1998;47:1-28. (Retrospective)
  57. * Meduri GU. Noninvasive positive pressure ventilation in patients with acute respiratory failure. Clin Chest Med 1996;17:513. (Review [this review is quite complete, although a bit dated in 2001])
  58. Meduri GU, Abou-Shala N, Fox RC, et al. Noninvasive face mask mechanical ventilation in patients with acute hypercapnic respiratory failure. Chest 1991;100:445-454. (Case series)
  59. Meduri GU, Cook TR, Turner RE, et al. Noninvasive positive pressure ventilation in status asthmaticus. Chest 1996;110:767-774. (Case series; 17 adult patients
  60. Pollack CV, Fleish KB, Dowsey K. Treatment of acute bronchospasm with beta-adrenergic agonist aerosols delivered by a nasal bilevel positive airway pressure circuit. Ann Emerg Med 1995;26:552-557. (Randomized; 100 patients)
  61. Dottorini M, Eslami A, Baglioni S, et al. Nasal-continuous positive airway pressure in the treatment of near-drowning in freshwater. Chest 1996;110:1122-1124. (Case report; 2 patients)
  62. Granton JT, Kesten S. The acute effects of nasal positive pressure ventilation in patients with advanced cystic fibrosis. Chest 1998;113:1013-1018. (Case report; 8 patients
  63. Strumpf DA, Carlisle CC, Millman RP, et al. An evaluation of the Respironics BPAP Bilevel CPAP Device of delivery of assisted ventilation. Respir Care 1990;35:415-422.
  64. Sanders MH, Kern N. Obstructive sleep apnea treated by independently adjusted inspiratory and expiratory positive airway pressures via nasal mask. Chest 1990;98:317-324.
  65. Muir JF, Cuvelier A, Verin E, et al. Noninvasive mechanical ventilation and acute respiratory failure: indications and limitations. Monaldi Arch Chest Dis 1997;52:56-59. (Review)
  66. * Hilbert G, Gruson D, Vargas F, et al. Noninvasive continuous positive airway pressure in neutropenic patients with an acute respiratory failure requiring intensive care unit admission. Crit Care Med 2000;28:3185-3190. (Prospective, uncontrolled; 129 adult patients enrolled, 64 patients actually studied)
  67. Rubenfeld GD, Crawford SW. Withdrawing life support from mechanically ventilated recipients of bone marrow transplants: A case for evidence based guidelines. Ann Intern Med 1996;125:625-633. (Retrospective, nested, casecontrol; 865 total patients, 56 selected patients, 106 selected controls)
  68. * Hilbert G, Gruson D, Vargas F, et al. Noninvasive ventilation in immunosuppressed patients with pulmonary infiltrates, fever, and acute respiratory failure [see comments]. N Engl J Med 2001;344(7):481-487. (Prospective, randomized, controlled; 52 patients)
  69. Confalonieri M, Potena A, Carbone G, et al. Acute respiratory failure in patients with severe community-acquired pneumonia. A prospective randomized evaluation of noninvasive ventilation [see comments]. Am J Respir Crit Care Med 1999;160(5 Pt 1):1585-1591. (Prospective, randomized, controlled; 56 patients)
  70. Brett A, Sinclair DG. Use of continuous positive airway pressure in the management of community acquired pneumonia. Thorax 1993;48(12):1280-1281. (Case report; 3 patients)
  71. L'Her E, Moriconi M, Texier F, et al. Non-invasive continuous positive airway pressure in acute hypoxaemic respiratory failure—experience of an emergency department. Eur J Emerg Med 1998;5(3):313-318. (Retrospective; 64 patients)
  72. * Bedos JP, Dumoulin JL, Gachot B, et al. Pneumocystis carinii pneumonia requiring intensive care management: survival and prognostic study in 110 patients with human immunodeficiency virus [see comments]. Crit Care Med 1999;27(6):1109-1115. (Case series; 110 patients)
  73. Ambrosino N, Foglio K, Rubini F, et al. Non-invasive mechanical ventilation in acute respiratory failure due to chronic obstructive pulmonary disease: correlates for success. Thorax 1995;50:755-757. (Retrospective; 59 episodes, 47 patients)
  74. Garfield MJ, Howard-Griffin RM. Non-invasive positive pressure ventilation for severe thoracic trauma. Br J Anaesth 2000;85(5):788-790. (Case report; 1 patient
  75. McEachern RC, Patel RG. Pneumopericardium associated with face-mask continuous positive airway pressure. Chest 1997;112:1441. (Case report
  76. Dodds WJ, Hogan WJ, Lyden SB, et al. Quantitation of pharyngeal motor function in normal human subjects. J Appl Physiol 1975;39:692-696. (Small scale adult measurement of esophageal sphincter pressure)

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